m_header1 = $header1; $this->m_header2 = $header2; } function addSize($text){ array_push($this->m_size,$text); } function generate(){ ?> m_size as $key=>$value){ ?>
m_header1; if($this->m_header2!=''){ echo '
' . $this->m_header2; } ?>
Size Quantity
_______
clear(); } function clear(){ $this->m_header1 = ''; $this->m_header2 = ''; $this->m_size = array(); } }// end of class ?> ORDER FORM

PRINTABLE ORDER FORM
or,
Download the Order Form in Word , or, PDF File ( Download PDF Reader Here )

Now Accepting All Major Cards. 
, , ,   USA
Tel.     Fax.     Toll Free      E-mail

PLEASE PRINT THIS ORDER FORM AND FAX IT TO US.
Thank you.

Bioteque's Silicone Pessaries
addHeader('MAR-LANDS(w/o)'); $of->addSize('M2.25 #2'); $of->addSize('M2.50 #3'); $of->addSize('M2.75 #4'); $of->addSize('M3.00 #5'); $of->addSize('M3.25 #6'); $of->addSize('M3.50 #7'); $of->addSize('M3.75 #8'); $of->generate(); ?> addHeader('MAR-LANDS(w)'); $of->addSize('M2.25S #2'); $of->addSize('M2.50S #3'); $of->addSize('M2.75S #4'); $of->addSize('M3.00S #5'); $of->addSize('M3.25S #6'); $of->addSize('M3.50S #7'); $of->addSize('M3.75S #8'); $of->generate(); ?> addHeader('DONUTS'); $of->addSize('D2.00 #0'); $of->addSize('D2.25 #1'); $of->addSize('D2.50 #2'); $of->addSize('D2.75 #3'); $of->addSize('D3.00 #4'); $of->addSize('D3.25 #5'); $of->addSize('D3.50 #6'); $of->generate(); ?> addHeader('SHAATZ'); $of->addSize('SH1.50 #0'); $of->addSize('SH1.75 #1'); $of->addSize('SH2.00 #2'); $of->addSize('SH2.25 #3'); $of->addSize('SH2.50 #4'); $of->addSize('SH2.75 #5'); $of->addSize('SH3.00 #6'); $of->addSize('SH3.25 #7'); $of->addSize('SH3.50 #8'); $of->generate(); ?> addHeader('RING w/Knob','(with support)'); $of->addSize('RK2.25S#2'); $of->addSize('RK2.50S#3'); $of->addSize('RK2.75S#4'); $of->addSize('RK3.00S#5'); $of->addSize('RK3.25S#6'); $of->addSize('RK3.50S#7'); $of->generate(); ?> addHeader('RING w/Knob','(without support)'); $of->addSize('RK2.25#2'); $of->addSize('RK2.50#3'); $of->addSize('RK2.75#4'); $of->addSize('RK3.00#5'); $of->addSize('RK3.25#6'); $of->addSize('RK3.50#7'); $of->generate(); ?>
addHeader('CUP (w/o)'); $of->addSize('CP50/18#0'); $of->addSize('CP55/23#1'); $of->addSize('CP60/28#2'); $of->addSize('CP65/33#3'); $of->addSize('CP70/38#4'); $of->addSize('CP75/43#5'); $of->addSize('CP80/48#6'); $of->addSize('CP85/52#7'); $of->generate(); ?> addHeader('CUP (w)'); $of->addSize('CP50/18S#0'); $of->addSize('CP55/23S#1'); $of->addSize('CP60/28S#2'); $of->addSize('CP65/33S#3'); $of->addSize('CP70/38S#4'); $of->addSize('CP75/43S#5'); $of->addSize('CP80/48S#6'); $of->addSize('CP85/52S#7'); $of->generate(); ?> addHeader('DISH (w/o)'); $of->addSize('DSH50 #0'); $of->addSize('DSH55 #1'); $of->addSize('DSH60 #2'); $of->addSize('DSH65 #3'); $of->addSize('DSH70 #4'); $of->addSize('DSH75 #5'); $of->addSize('DSH80 #6'); $of->addSize('DSH85 #7'); $of->generate(); ?> addHeader('DISH (w)'); $of->addSize('DSH50S #0'); $of->addSize('DSH55S #1'); $of->addSize('DSH60S #2'); $of->addSize('DSH65S #3'); $of->addSize('DSH70S #4'); $of->addSize('DSH75S #5'); $of->addSize('DSH80S #6'); $of->addSize('DSH85S #7'); $of->generate(); ?> addHeader('RINGS (w/o)'); $of->addSize('R1.75 #0'); $of->addSize('R2.00 #1'); $of->addSize('R2.25 #2'); $of->addSize('R2.50 #3'); $of->addSize('R2.75 #4'); $of->addSize('R3.00 #5'); $of->addSize('R3.25 #6'); $of->addSize('R3.50 #7'); $of->addSize('R3.75 #8'); $of->addSize('R4.00 #9'); $of->generate(); ?> addHeader('RINGS (w)'); $of->addSize('R1.75S #0'); $of->addSize('R2.00S #1'); $of->addSize('R2.25S #2'); $of->addSize('R2.50S #3'); $of->addSize('R2.75S #4'); $of->addSize('R3.00S #5'); $of->addSize('R3.25S #6'); $of->addSize('R3.50S #7'); $of->addSize('R3.75S #8'); $of->addSize('R4.00S #9'); $of->generate(); ?>
addHeader('HODGE (w/o)'); $of->addSize('HD65 #0'); $of->addSize('HD70 #1'); $of->addSize('HD75 #2'); $of->addSize('HD80 #3'); $of->addSize('HD85 #4'); $of->addSize('HD90 #5'); $of->addSize('HD95 #6'); $of->addSize('HD100 #7'); $of->addSize('HD105 #8'); $of->addSize('HD110 #9'); $of->generate(); ?> addHeader('HODGE (w)'); $of->addSize('HD65S #0'); $of->addSize('HD70S #1'); $of->addSize('HD75S #2'); $of->addSize('HD80S #3'); $of->addSize('HD85S #4'); $of->addSize('HD90S #5'); $of->addSize('HD95S #6'); $of->addSize('HD100S #7'); $of->addSize('HD105S #8'); $of->addSize('HD110S #9'); $of->generate(); ?> addHeader('CUBES (w/o)'); $of->addSize('CU25 #0'); $of->addSize('CU29 #1'); $of->addSize('CU33 #2'); $of->addSize('CU37 #3'); $of->addSize('CU41 #4'); $of->addSize('CU45 #5'); $of->addSize('CU50 #6'); $of->addSize('CU56 #7'); $of->addSize('CU63 #8'); $of->addSize('CU70 #9'); $of->addSize('CU75 #10'); $of->generate(); ?> addHeader('CUBES (w)'); $of->addSize('CU25D #0'); $of->addSize('CU29D #1'); $of->addSize('CU33D #2'); $of->addSize('CU37D #3'); $of->addSize('CU41D #4'); $of->addSize('CU45D #5'); $of->addSize('CU50D #6'); $of->addSize('CU56D #7'); $of->addSize('CU63D #8'); $of->addSize('CU70D #9'); $of->addSize('CU75D #10'); $of->generate(); ?> addHeader('GELLHORNS (w)'); $of->addSize('G1.50D #0'); $of->addSize('G1.75D #1'); $of->addSize('G2.00D #2'); $of->addSize('G2.25D #3'); $of->addSize('G2.50D #4'); $of->addSize('G2.75D #5'); $of->addSize('G3.00D #6'); $of->addSize('G3.25D #7'); $of->addSize('G3.50D #8'); $of->generate(); ?> addHeader('Short Stem GELLHORNS (w)'); $of->addSize('G1.50S #0'); $of->addSize('G1.75S #1'); $of->addSize('G2.00S #2'); $of->addSize('G2.25S #3'); $of->addSize('G2.50S #4'); $of->addSize('G2.75S #5'); $of->addSize('G3.00S #6'); $of->addSize('G3.25S #7'); $of->addSize('G3.50S #8'); $of->generate(); ?>
addHeader('OVALS (w/o)'); $of->addSize('OV2.00 #1'); $of->addSize('OV2.25 #2'); $of->addSize('OV2.50 #3'); $of->addSize('OV2.75 #4'); $of->addSize('OV3.00 #5'); $of->addSize('OV3.25 #6'); $of->addSize('OV3.50 #7'); $of->addSize('OV3.75 #8'); $of->addSize('OV4.00 #9'); $of->generate(); ?> addHeader('OVALS (w)'); $of->addSize('OV2.00S #1'); $of->addSize('OV2.25S #2'); $of->addSize('OV2.50S #3'); $of->addSize('OV2.75S #4'); $of->addSize('OV3.00S #5'); $of->addSize('OV3.25S #6'); $of->addSize('OV3.50S #7'); $of->addSize('OV3.75S #8'); $of->addSize('OV4.00S #9'); $of->generate(); ?> addHeader('GEHRUNG (w)'); $of->addSize('GH50S #0'); $of->addSize('GH55S #1'); $of->addSize('GH60S #2'); $of->addSize('GH65S #3'); $of->addSize('GH70S #4'); $of->addSize('GH75S #5'); $of->addSize('GH80S #6'); $of->addSize('GH85S #7'); $of->addSize('GH90S #8'); $of->generate(); ?> Pessary Fitting Set  ( FS 1000 )
Six of the most commonly used pessaries packed in an attractive case.
The FS1000 is used to determine proper patient pessary use.

 

 

 

 

The Curelle ( RD003 - 3MM )   

The preferred Curelle ( M0014 - 3mm )

( With twist and lock syringe - To obtain sample of endometrial tissue ) 

Quantity

_______ 25
_______ 50
 _______ 100

( To obtain sample of uterine mucosal lining ) 

Quantity

_______ 25
_______ 50
  _______ 100

VABRA ASPIRATOR (TC-500 ) 

Future Product  

  • With transparent 4mm cannulas. Min. Order 12 Units.

  • Transparent Cannulas sizes 5,6,7,8 mm. Min. Order 12 Units. 

  • With stainless stell 2mm or 3mm cannulas. Min. Order 12 Units. 

 

( To obtain sample of uterine mucosal lining ) 

Quantity

_______ 25
_______ 50
 _______ 100

LAMINARIA

 
Quantity Product # Size

_______________
_______________
_______________
_______________
_______________

L 102
L 103
L104
L105
L106

Extra Small
Small
Medium
Large
Extra Large

 
Diameter Quantity
? 2 mm
?3 mm
?4 mm
?5 mm
?6 mm


______  1-11
______  12-53
______  36-59
______  60-144

NICHOLS SILICONE COUNSELOR 

Quantity Product # Size Dimensions
_______
_______
_______
_______
C 116 S
C 125 M
C 133 L
Complete Set 
( L = 116.75 mm )
( L = 125.50 mm )
( L = 133.75 mm )
All sizes
O.D = 30.75 mm, Drain = 13.75 mm
O.D = 33.50 mm, Drain = 14.75 mm
O.D = 41.70 mm, Drain = 15.75 mm

CYTOLOGY BRUSH ( CB -101 )

Quantity

                        _______  1-999
                        _______  1000-4999
                        _______  5000-9999
                        _______  10,000 + 

 

WORD / BARTHOLIN CATHETER 9 ( WC - 400 mm )

Includes 6 syringes, 6 catheters and 6 scalpels 

VAGINAL WEIGHTS ( VGT - 600 ) 

5 wgts. graduated 20-70 gms.




SILICONE VAGINAL DIALATORS 
3 FAMILIES OF 4 DIALATORS EACH

Quantity

_______  Large Set DT-A
    _______  Medium Set DT-B
_______  Small Set DT-C

 

 

 

  Sizes Available Dialators 
Height 
Small 
Diameter 
Large 
Diameter 


Large
DT-A XL
DT-A L
DT-A M
DT-A S
150.0
138.0
128.0
120.0
30.0
25.0
22.5
19.5
38.0
32.0
28.0
24.0


Medium 
DT-B XL
DT-B L
DT-B M
DT-B S
95.0
86.0
78.0
75.0
26.0
22.5
19.5
12.5
33.0
28.0
23.0
17.0


Small 
DT-C XL
DT-C L
DT-C M
DT-C S
75.0
65.0
60.0
50.0
13.5
12.0
10.5
9.5
18.0
16.0
14.0
13.0

All Dimensions are in millimeters

 
ASPIRATION SETS WITH SOUND & FLEXIBLE CATHETER
Number Product Quantity
57 - 980S Aspiration Set 3 mm _______ Box / 25
R 57 - 891S Aspiration Set 4 mm _______ Box / 25
R 57 - 982S Aspiration Set 5 mm _______ Box / 25
R 57 - 983S Aspiration Set 6 mm _______ Box / 25
R 57 - 985S Aspiration Set 7 mm _______ Box / 25
BA05F HSG Catheter Set
Flexible, ballon-tipped catheter 5F for hysterosalpingography and sonohysterography
_______ Box / 10
BA07F HSG Catheter Set
Flexible, ballon-tipped catheter 7F for hysterosalpingography and sonohysterography
_______ Box / 10
Ly 06 - 300 F Multi-Purpose OB/GYN Procedure Tray 
Complete procedure tray without catheter
_______ Box / 10
Ly 06 - 305 F
Ly 06 - 307 F
PROCEDURE TRAY 
Complete procedure tray with
 (06-305F) or 7F (06-307F) catheters
_______ Box / 10
UIC5F ULTRA CATHETER
Flexible, non-ballon catheter for sonohysterography
_______ Box / 25
OS265BA-1
DISPOSABLE OS FINDERS _______ Box / 50
OS265BA-2
DISPOSABLE CANAL LOCATOR _______ Box / 50
OS265BA-3
DISPOSABLE FUNDUS FINDER _______ Box / 50
BAOFS - 3 OS/CANAL/FUNDUS Set (3) 
(Gentle Cervical Dialation)
_______ Set / 3
BP - 700 DISPOSABLE BIOPSY PUNCH 
ALL SIZES AVAILABLE
_______ Box / 25
_______ Box / 50

 

GERMAN QUALITY / OR GRADE INSTRUMENTS 

CERVICAL BIOPSY PUNCH FORCERS

  • Tischler                           Quantity   _______       

  • Burke                              Quantity   _______ 

  • Townsend                        Quantity   _______                                  

  • Kevorkian                        Quantity   _______ 

  • Eppendorfor                     Quantity   _______ 

SPECULUMS   ( Disposable Speculums also available ) 

  • Graves                           Quantity   _______

  • Pedersen                       Quantity   _______

  • Weisman                       Quantity   _______

 

LEEP Electrode Order Form 

Size  Part Nr. Type  Quantity
5mm x 5mm

5mm x 5mm


10mm x 5mm
10mm x 7mm

10mm x 8mm


10mm x 8mm
10mm x 10mm
15mm x 7mm
15mm x 10mm

15mm x 13mm


15mm x 15mm
20mm x 8mm
20mm x 10mm

20mm x 12mm
20mm x 15mm
20mm x 20mm
25mm x 10mm
3 mm Ball
5 mm Ball


BOX 

B-0505

0B-0505S Square


0B-100S
0B-1007

0B-1008


0B-1008S
0B-1010
0B-1507
0B-1510

0B-1513


0B-1515
0B-2008
0B-2010

0B-2012
0B-2015
0B-2020
0B-2510
0B-3B
0B-5B


0B-5X

Loop "Sterile" single use

Loop "Sterile" single use "NEW"


Loop "Sterile" single use
Loop "Sterile" single use

Loop "Sterile" single use "NEW"


Loop "Sterile" single use
Loop "Sterile" single use
Loop "Sterile" single use
Loop "Sterile" single use

Loop "Sterile" single use "NEW"


Loop "Sterile" single use
Loop "Sterile" single use
Loop "Sterile" single use

Loop "Sterile" single use
Loop "Sterile" single use
Loop "Sterile" single use
Loop "Sterile" single use
Ball "Sterile" single use
Ball "Sterile" single use


Blank Box (holds 5 Electrodes)


TOTAL

_______________________

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_______________________
_______________________

_______________________



_______________________
_______________________
_______________________
_______________________

_______________________



_______________________
_______________________
_______________________

_______________________
_______________________
_______________________
_______________________
_______________________
_______________________


_______________________


_______________________


PLEASE TYPE OR PRINT CLEARLY


Shipping and billing address the same ?  Yes____  No ____

SHIP TO :
Name : ____________________________________________  PO# ___________
Address : ______________________________________________________________
City : ______________________ State : ___________ Zip : __________
Telephone : _____________________   Fax : _____________________  E-mail : ________________

Signature ( required ) : __________________________________________________________________

Account # : ___________________________ Invoice # : _________________________________

Let Bioteque source your specialty products
Telephone and fax orders are welcome. For high quantity discounts or help with order, call us at 1-800-889-9008
Bioteque's prices are subject to change without notice

Medical Products, Design & Development, Prototypes to Production.
Call for Quantity Discounts.
 

Orders will be billed net 30 days. Bioteque America Inc., will add shipping and handling cost plus any applicable sales tax for products shipped within PA.

PLEASE TYPE OR PRINT CLEARLY [013001C]

BILL TO :


Name
: ____________________________________________  PO# ___________
Address : ______________________________________________________________
City : ______________________ State : ___________ Zip : __________
Telephone : _____________________   Fax : _____________________  E-mail : ________________

Signature ( required ) : __________________________________________________________________

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